Perioperative psychosocial interventions for autistic children undergoing ENT surgery

doi:10.1016/S0165-5876(97)01507-3

International Journal of Pediatric Otorhinolaryngology

Volume 40, Issues 2–3, 20 June 1997, Pages 107-113

https://doi.org/10.1016/S0165-5876(97)01507-3 Get rights and content

Abstract

Tonsillectomy/adenoidectomy is one of the most frequently performed operations in the United States. It is therefore likely that pediatric ENT surgeons will encounter autistic and developmentally delayed children in routine practice. Autistic children differ from normal children in that they exhibit severe deficits in language and social functioning; abnormal reaction to stimuli such as light, sound, touch, and pain; attachments to particular unusual objects and rigidly stereotyped routines. They are often mentally retarded. With the increasing importance of managed care and continuous quality improvement, knowledge of how to manage the operative course of such children is crucial for the practising surgeon. Based on research and clinical knowledge of these children, certain psychosocial and medical interventions are presented which may improve the operative course of this population. Using the parent as a consultant; decreasing separation from familiar caretakers, objects, and routines; pre-operative role-playing; tailoring anesthetic induction; and using post-operative distractors are suggested techniques.

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Cited by (35)

Management of Procedural Pain and Anxiety in Youth With Autism Spectrum Disorder: A Scoping Review
2024, Pain Management Nursing
Although there is a body of literature on the implementation of interventions to manage procedural pain and anxiety in youth with autism spectrum disorders (ASD), we found no literature presenting the current state of knowledge on this topic.
To review the state of knowledge on interventions for the management of procedural pain and anxiety in children and adolescents with ASD.
A scoping review using PRISMA-ScR was conducted.
PubMed, MEDLINE, all EBM reviews, Embase, APA PsychInfo, EBSCO CINAHL, and ProQuest Dissertations and Theses Global databases were searched. Gray literature was also searched.
Braun and Clarke's (2006) model for thematic analysis in psychology was used to synthesize the search results.
Thirty articles were selected. Analysis of the extracted data revealed four elements of intervention for better management of procedural pain and anxiety in the study population: 1) characteristics of the procedure and the immediate environment; 2) parent-child interactions; 3) health care provider-child interactions; and 4) direct pharmacological and nonpharmacological interventions.
Nurses must be able to implement appropriate interventions for the management of procedural pain and anxiety in youth with an autism spectrum disorder.
Surgical management of the patient living with autism
2019, Surgery Open Science
Citation Excerpt :
It may also be helpful to avoid separation from the patients' caregivers as much as possible. In the operating room, the caregiver could be present both during the induction of anesthesia and later when the patient wakes up and recovers [9,22]. Using the patient's familiar bedding and decorations may also help to reduce anxiety and stress prior to and after surgical intervention [23].
Although 1 in 59 children currently born are diagnosed with autism spectrum disorder (ASD), little is known on how to best manage those patients who require surgical intervention.
The purpose of this study is to (1) investigate the best care strategies for surgical patients living with autism spectrum disorder (2) provide recommendations on how to apply those strategies to clinical practice.
A literature review was conducted to investigate the best clinical practices for optimizing surgical care for individuals living with autism spectrum disorder. Relevant articles were selected and examined, and individual references from those articles were manually searched using Ovid Medline and Google Scholar.
The wide spectrum of symptoms associated with autism spectrum disorder pose unique challenges for surgical management. Early coordination with the patient and family optimizes the development of an effective care plan. Strategies include identifying triggers for anxiety as well as soothing mechanisms, performing surgery in the morning, completing preoperative paperwork prior to surgery, choosing appropriate analgesia and anxiolytics, and fast resumption of normal routines. Based on these findings a surgical checklist was created to aid in treating the patient with autism spectrum disorder. The checklist provides insight into navigating the surgical experience and emphasizes planning surgical interventions to most effectively fit individual patient needs.
The surgical treatment of those living with autism spectrum disorder poses unique challenges for the health care team. The widespread adoption of such individualized approaches encompassing pre/intra/post-operative will become more important as these children grow into adults with increased needs for surgical services.
Improving management of patients with autism spectrum disorder having scheduled surgery: Optimizing practice
2014, Journal of Pediatric Health Care
Citation Excerpt :
The patient's mother was involved in all discharge planning and medical care plans (Dell et al., 2008). Published recommendations from a pediatric otorhinolaryngology group who frequently performed ear/nose/throat surgeries on autistic children again emphasized communication with the family prior to the day of surgery (Seid, Sherman, & Seid, 1997). They recommend asking parents about the child's likes and dislikes and assessing if the child is particularly sensitive to blinking lights or noises or if he or she has specific fears.
Surgical preparation for children with autism spectrum disorders can be a challenge to perioperative staff because of the unique individual needs and behaviors in this population. Most children with autism function best in predictable, routine environments, and being in the hospital and other health care settings can create a stressful situation. This prospective, descriptive, quality improvement project was conducted to optimize best practices for perioperative staff and better individualize the plan of care for the autistic child and his or her family.
Forty-three patients with a diagnosis of autism or autistic spectrum disorder were seen over 6 months at a suburban pediatric hospital affiliated with a major urban pediatric hospital and had an upcoming scheduled surgery or procedure requiring anesthesia. Caregivers were interviewed before and after surgery to collect information to better help their child cope with their hospital visit.
In an evaluation of project outcomes, data were tabulated and summarized and interview data were qualitatively coded for emerging themes to improve the perioperative process for the child.
Findings showed that staff members were able to recognize potential and actual stressors and help identify individual needs of surgical patients with autism. The families were pleased and appreciative of the individual attention and focus on their child's special needs. Investigators also found increased staff interest in optimizing the surgical experience for autistic children.
The health care experiences of the preschool child with autism
2012, Journal of Pediatric Nursing
Citation Excerpt :
Many mothers in the study felt stress and anxiety over their need to “drive” the health care visit by repeating child-specific instructions and information on every visit. Using the parent as a consultant in developing a profile for care was recommended by Seid et al. (1997) in their study on perioperative interventions for children with ASD. The authors found that fostering that collaborative relationship and using the parent as a resource minimized negative outcomes for the child with ASD (Seid et al., 1997).
It is known that children with autism spectrum disorder (ASD) visit health care providers (HCPs) more frequently than typically developing peers, and mothers experience barriers in this process. The purpose of this interpretive phenomenological study was to gain a better understanding of a mother's experiences of taking her child with ASD to the HCP. Two themes related to the health care experience of the child surfaced from the study. These themes included feelings that HCPs do not “get” the complexity of caring for the child and marginalization of mothers by the HCP. The need for creation of child-specific profiles emerged from this study.
Dexmedetomidine for Procedural Sedation in Children With Autism and Other Behavior Disorders
2009, Pediatric Neurology
Citation Excerpt :
For several reasons, including tactile aversion, decreased ability to adapt to altered routines, diminished ability to process situational needs, and behavior disorders, including potentially profound aggression, children with autism or autism spectrum disorders can be difficult patients in whom to perform procedures [1-4].
Dexmedetomidine has been increasingly in use for pediatric noninvasive procedural sedation. This retrospective study examined experience in children with autism and other neurobehavioral disorders, populations often difficult to sedate. Records of children with autism or neurobehavioral disorders sedated with dexmedetomidine at Chris Evert Children's Hospital and Kosair Children's Hospital were reviewed. Demographic and sedation-related data were collected, including sedative doses, time to sedation, efficacy, and complications. Comparisons of sedative doses, efficacy between autism and neurobehavioral patients, and analysis of age-related factors were performed. In all, 315 patients were sedated, most commonly for magnetic resonance imaging. Mean induction and total dexmedetomidine doses were 1.4 ± 0.6 and 2.6 ± 1.6 μg/kg, respectively, with no differences between autism and neurobehavior patients. Most patients (90%) patients received concomitant midazolam. There was an age-related decrease in dexmedetomidine dose, independent of midazolam use. Seven patients required intervention for hypotension, bradycardia, or both, and only one adverse respiratory event (obstruction requiring nasopharyngeal airway placement) occurred. There were two episodes of overt recovery-related agitation. All but four procedures were successfully completed (4/315, or 98.7%). Dexmedetomidine with or without midazolam was an effective sedative in this population. The regimen appeared to be well tolerated with few adverse events, including recovery-related agitation, and appears to be an attractive option for this population.
Morbidity after tonsillectomy in children with autism spectrum disorders
2019, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
As the incidence of autism spectrum disorder (ASD) increases, otolaryngologists are more likely to encounter patients from this population during tonsillectomy. The purpose of this study was to examine whether outcomes differ between pediatric patients with and without ASD in a national cohort of children undergoing tonsillectomy. Understanding these differences may be used to inform future approaches to improve clinical outcomes and healthcare costs.
Data for this study were obtained from the Kids Inpatient Database (KID) of the Healthcare Cost Utilization Project. We studied pediatric patients who underwent tonsillectomy during 2003, 2006, 2009, and 2012. Tonsillectomy was identified using ICD-9-CM diagnosis codes 28.2 (tonsillectomy without adenoidectomy) and 28.3 (tonsillectomy with adenoidectomy). ASD was identified using ICD-9-CM diagnosis code 299 (autism). Outcomes including complications, length of hospital stay, and total hospitalization costs. Analyses were performed using multivariable models. Propensity score matching was used to control for covariate imbalance between patients with and without ASD.
In our sample of 27,040 patients, 322 (1.2%) had a diagnosis of ASD. After controlling for potential confounders, multivariable modeling suggested patients with ASD had a shorter LOS of 0.50 days (p < 0.0001), were less likely to experience complications (odds ratio 0.57, p = 0.001), and had lower associated costs of $1308 less (p < 0.0001). Propensity score matching confirmed the findings of the multivariable modeling.
Although ASD alone does not appear to confer additional costs or morbidity, differences between children with and without ASD suggest the need for providers to address patients with ASD uniquely.

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¹: Present address: North Coastal Mental Health Clinic, 1701 Mission Ave. Oceanside, CA 92054, USA.

²: Present address: Pediatric Otolaryngology Associates, 3030 Children's Way, # 402, San Diego, CA 92123, USA.

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Research reportPerioperative psychosocial interventions for autistic children undergoing ENT surgery

Abstract

J. Am. Acad. Child and Adol. Psychol.

Attachment and loss: Vol. 1. Attachment

First report of a Canadian epidemiological study of autistic syndromes

J. Child Psychol. Psychiatry

The Biology of the Autistic Syndromes

Research report
Perioperative psychosocial interventions for autistic children undergoing ENT surgery